Before surgery attempt to do the following:

• Blood pressure will be appropriate for gestational age with a MAP at least 25-30 if not volume resuscitate.

• Hematocrit will be 35 or better if not transfuse over 20 minutes

• pH will be at least 7.2

• Baby will be intubated and ventilated in the NICU

• FFP (10cc/kg)  will be given due to the diagnosis rather than waiting on coags since the babies become coagulopathic when operated

• Platelets as needed to have platelet count over 50,000-100,000

• IV access to include as a minimum two peripheral IV’s or one peripheral IV and a central line.

•  Arterial access.

• Type and cross for blood

• Discontinue the TPN and lipids and hang clear fluid to include glucose and either NS or LR